Here are some forms that may be useful in managing your group insurance plan.
Are you looking for other forms?
Health Care Benefits
Health insurance claim (drugs, health care professionals, vision care expenses, etc.)
Foreign Nationals in Canada and Canadians Working Abroad
Health insurance claim for work abroad, whatever the nationality.
Prior Authorization - Exception Drugs or Limited Use Drugs
Prior authorization in the case of a claim for exception drugs or limited use drugs.
Request for brand name drug coverage
This form has to be completed by your physician to assess your request for coverage of a non-generic drug.
Dental Care Benefits
Dental claim when you do not have access to the direct payment system. Note that a section of the form must be completed by your dentist.
Health Spending Account
Benefit claim with Health Spending Account
Claim for the portion of health and dental care insurance expenses which are not covered or exceed the coverage stipulated under your contract. You must already have a health spending account under your group insurance contract to use this form.
Benefit claim for your Wellness account
Claim for expenses related to wellness activities. A detailed list of amounts eligible can be found in your insurance booklet. You must already have a wellness account under your group insurance contract to use this form.
Accidental Death and Dismemberment (ADD)
Notice of Claim
Report a loss in the case of accidental death or dismemberment.
Proof of Loss in the Case of Accident
Proof of loss in the case of an accident.
Student Accident Insurance - Proof of Loss
Proof of loss when an accident occurs while participating in a school activity.
Sports Accident Insurance - Proof of Loss
Proof of loss when an accident occurs while participating in a sport.
Dental Claim - Proof of Loss in the Case of a Sports Accident
Proof of loss to be filled out by the attending dentist if dental care is required following an accident that occurred while participating in a sport.
Dental Claim - Claim in the Case of an Accident
Claim to be filled out by the attending dentist for dental care received following an accident.
Authorization for Direct Debit Payments - Personal PAD
Authorization for the payment of your monthly insurance premium by preauthorized debit (SSQ Privilege).
Direct Deposit of your Health and Dental Care Insurance Benefits
Registration for direct deposit of your health and dental care insurance benefits.
Consent to Collect
Consent to collect and disclose personal information to a third party.
Proof of travel insurance coverage
Proof of travel insurance for the insured person who is covered under an individual or group insurance contract.